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A male asked:

nerve damage to groin and hip area after illiac crest bone harvest. what's it called and is it reversable? six months post op. cervical fusion of c6-c7 with autograft from hip and hardware. sensations range from numb, sharp quick pins and needles and sand

2 doctor answers5 doctors weighed in
Dr. Monica Wood
Hand Surgery 28 years experience
There : There are a few nerves around the pelvis that could be injured during graft harvest. The most common one is the lateral femoral cutaneous nerve which supplies the skin on the outside of the thigh. From your description, it is more likely the ilioinguinal or pedundal nerve that is affected. Since i don't know where the bone was harvested (anterior or posterior crest), i don't know how the nerve might have been injured. Most of these nerve injuries are what are called neurapraxias. The nerves recover with time, but can be painful for several months to a year. A charring injury from the cautery used during surgery also recovers with time. If the nerve is partially (axonotmesis) or completely (neurotmesis) severed, the recovery is less predictable. The nerve fibers have to regrow and find their way to the nerve endings. If they "get lost" they can cause a painful ball of nerve fibers called a neuroma. Nerves take a month to start growing and grow at 1mm/day or about an inch a month. Based on the location of the injury and the distance to the nerve endings, it can take a long time to regenerate. Injured nerves can be very irritable and send any stimulus as a painful signal. To quiet the nerve, we use desensitization techniques. By constantly giving the nerve a low level stimulus, it "learns" what is normal and stops the painful signal. Then you increase the stimulation until that feels normal. While Neurontin can be helpful, I have had better pain control (though not necessarily side effects) with lyrica (pregabalin). Insurers are often reluctant to cover it because it's more expensive. Amitriptyline or nortriptyline can enhance the effects, but also add to the sedation. It is possible you may need surgery to explore the nerve and remove a possible neuroma, though that would likely leave an area of numbness. Only your surgeon knows what the likelihood of that is. Nerve conduction studies usually are not very helpful in this area and can be painful to get, particularly if the nerve is quite irritable. To date we do not have any means of making nerves function. We can decompress them, repair them, remove neuromas, and even transfer them, but they have to work on their own. Maybe in the future we will have nerve growth factors or stem cells to help boost nerve function. For now, however, nerve pain remains a frustratingly difficult problem.
Dr. James Cole
Orthopedic Spine Surgery 32 years experience
No, not usually: During harvest of the hip graft, the anterior femoral cutaneous nerve was most likely injured. This nerve runs over the hip very close to where we take the graft. It can heal over a 12 month period, but if you are 6 months from surgery and still have not improved, then it is unlikely to get better.

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Last updated Oct 3, 2016


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